Confirmed 2016 QHPs: 12,646,624 (+at least 295K purged)
FINAL PROJECTION: 12.4M - 12.9M 1/31/16 (9.4 - 9.8M via HC.Gov)
ORIGINAL PROJECTION: 14.7M nationally (11.2M via HC.gov)  •  State by State

DISCLOSURE: This is a sponsored post. HealthNetwork is a healthcare marketing company that reaches more than 15 million health insurance shoppers annually and connects consumers with health plans.

Sponsor Message: At HealthNetwork, we're entirely focused on improving the consumer experience when it comes to researching and enrolling in a health insurance plan. We are neither a health insurance broker, nor are we a "lead gen" company that collects information from consumers and resells it to third parties. We simply allow consumers to research their options and enroll in a plan in the method that is best for their specific needs - online, telephonically or even meeting face-to-face with a licensed insurance professional.

NOTE: THIS IS AN UPDATED/EXPANDED VERSION OF MY "PRE-MORTEM" FROM 1/28/16.

Also see these three additional entries for more major OE3 analysis:

I noted over a week ago that, after seeing the writing on the wall for several weeks and lowering my final 2016 Open Enrollment Period projection from 14.7 million to around 13.8 million, the time had come to lower it once again, to somewhere between 12.4 - 12.9 million.

As announced yesterday, the official QHP selection number ended up coming in right in the middle of this: 12.7 million nationally (9.6 million via HC.gov).

So...what went wrong? Well, from the HHS Dept's POV, nothing...or at least nothing that they didn't already project last October. They had already openly stated that they didn't expect any dramatic exchange enrollment increases this year, giving a wide open enrollment range of 11.0 - 14.1 million QHP selections...which has a mid-range of 12.6 million.

The better question is how I managed to be off by so much, overestimating (originally) by a whopping 2 million people, Obviously I can't be expected to nail every number, but that would be the least-accurate projection I've had to date (overshooting by 15.7%).

There's still a handful of enrollees left to be added to the state-level numbers (perhaps 60K or so collectively), but it's time to look at the major reasons for the shortfall.

Some of these are well-documented criticisms: Premiums and/or deductibles are simply too damned high for many policies/regions in general. This post is not about price/affordability issues, however; this is about more specific factors.

First, let's take a look at the state-by-state enrollment table, sorted highest to lowest in terms of how well each did vs. my personal projections:

Very nicely done, Access Health CT:

In all, 116,019 Connecticut residents signed up for private insurance through the state’s health insurance exchange, Access Health CT, during the open enrollment period that ended last week, officials said Monday.

That figure is slightly higher than the 110,095 who signed up during last year’s enrollment period and exchange officials’ goal for this year of signing up 105,000 to 115,000.

Connecticut only improved over last year by about 5.4%, but much of that is because, according to the Kaiser Family Foundation, CT only had around 62,000 uninsured people eligible for APTC assistance to begin with (they also have around 100K more uninsured who'd have to pay full price if they enrolled via the exchanges, but those people can get the same policies off-exchange anyway, and many very well might have done just that).

Thanks to Dee for the heads up: From yesterday's New York Times: 

Emails released last week by the State Department that were found on Mrs. Clinton’s private server show that she was keenly interested in the administration’s push to win passage of the health care law.

...The email messages show that throughout the fall of 2009, as the health care push entered a decisive phase, Mrs. Clinton lobbied some members of Congress for votes and even debated sometimes-esoteric policy proposals with aides, some of whom had worked with her in the White House when she was first lady, after her own failed attempt to push a national health care overhaul.

...Congressional officials who worked on the Affordable Care Act said that Mrs. Clinton was an important and effective advocate.

Yet another development in the Saga of Form 8962:

As you may recall, last year...

  • About 316,000 households that got tax credits paid to them in advance but did not file any return at all last year. Before the healthcare law, many low-income people were not required to file taxes. Now they must do so if they got a subsidy. But if taxpayers don't realize it, that can create mix-ups.
  • Some 976,000 households that got tax credits and filed 2014 returns, but omitted a new form that is the key to accounting for their subsidies. Called Form 8962, it was introduced for the 2015 tax filing season.
  • About 147,000 households that had requested extensions to file their 2014 taxes, but never followed through.

For the past few weeks, I've been pointing out some of the reasons why a wholesale replacement of the entire U.S. healthcare system with a universal, comprehensive, single payer system in one shot (or even a short-term series of shots) would be absurdly improbable to happen even if Bernie Sanders not only won the Presidency (which, unlike some people, I do think could happen), but also somehow managed to along solidly progressive majorities in both the House and Senate (which, I'm sorry, I just don't). I then took a closer look at the ideas which Hillary Clinton has proposed so far, and found them to be important but mostly minor improvements.

This led me to ask the question, "If Bernie is promising too much, too quickly...is Hillary not promising enough, ever?"

No sooner had I posted my big "wrap-up" reports when Rachel Karas of Inside Health Policy gives me the following heads up:

.@kynectky 2016 enrollment numbers as of today: QHP: 93,687; total Medicaid: ~1.3M; Total in expanded Medicaid: 437,091 cc: @acasignups

— Rachel S. Karas (@rachelkaras) February 5, 2016

Hmmm...OK, I guess "as of today" means I need to make the "thru date" 2/04/16 instead of 1/31 or 2/01, but whatever; the point is that this is Kentucky's final official total.

Kynect's total was 81,121 as of 12/26, so they only added about 12,500 more since Christmas. 93,687 is only around 75% of the 125K I was expecting, and is over 12,600 fewer private enrollees than they had last year, making them one of only 8 states to drop their open enrollment total.

In fact, each of the other 7 are special cases:

*(with 5 exceptions; see below)

The final numbers (through either 1/31, 2/01 or 2/02 depending on the state) are now in for 44 states plus DC. There are still 6 states which are missing some enrollment data:

  • Idaho: 5 days missing
  • Massachusetts: 31 days missing
  • New York: 7 days missing
  • Vermont: 36 days missing

UPDATE 2/5/16: Kentucky just released their numbers.

UPDATE 2/8/16: Connecticut has released their numbers.

Your Health Idaho informs me that their official final OE3 total won't be announced until after February 15th, but here's a quick mini-update:

More than 97,000 Idahoans Select Insurance through Idaho Exchange
Lawmakers Get Update on Your Health Idaho’s Progress

BOISE, Idaho – Your Health Idaho executive director Pat Kelly went before lawmakers on Tuesday to give them an update on the second year of operations for Idaho’s state-based health insurance exchange. Kelly said Idahoans have benefitted from state lawmakers’ choice to keep the federal government out of Idaho’s health insurance decisions.

Currently, more than 97,000 Idahoans have selected a health insurance plan through the exchange. In 2015, Idaho ranked fourth in the nation per-capita for enrollments and had the highest enrollment numbers of any state-based health insurance exchange.

YHI also makes a strong case for keeping full state exchanges as opposed to moving to HealthCare.Gov (Matt Bevin of Kentucky might want to take notice...):

This Just In...the DC exchange has issued their official enrollment report as well (note: remember that this includes the first 2 days of February as well):

DC Health Link Individual Marketplace Data for Third Open Enrollment Period

61% of New Customers are 34 years old and Younger

Washington, DC­­ – Today, the DC Health Benefit Exchange Authority (HBX) released preliminary individual marketplace data for the third open enrollment period for DCHealthLink.com, the District’s online health insurance marketplace for individuals, families and small businesses.

The third open enrollment period for individuals and families ended January 31, 2016.  District residents had two extra days to enroll due to the historic snow storm that hit the DC region.   Data includes people enrolling from November 1, 2015 to February 2, 2016.

There are 22,912 customers with 2016 health insurance coverage through DC Health Link’s individual marketplace:

OK. As expected, HHS released the "top line" number for the 2016 Open Enrollment Period: 12.7 million Qualified Health Plan enrollments nationally.

On the one hand, yes, I blew it this year: This is almost exactly 2.0 million fewer than the 14.7 million I originally projected for this year.

HOWEVER, as I've noted many times before, this isn't an apples to apples comparison, because that 12.7 million is after subtracting a minimum of 300,000 cancelled plans (pre-purging). The first two years, any plan cancellations during open enrollment weren't subtracted until after the dust settled; this year, due to improved backend software, CMS was able to purge/remove most cancelled plans from HC.gov on the fly.

In other words, an apples to apples comparison of the actual grand total of QHP selections vs. the same figure last year is at least 13.0 million (actually somewhat higher, since CMS hasn't released the total number of "pre-purges").

  • PRELIMINARY numbers since they still have an overtime period
  • 100K in final 4 days
  • 425K new consumers (295K - 450K target)
  • 18-34: 37% of new folks vs. 29% & 34% in first 2 years
  • That means better rates/more stable market
  • weighted avg. of 4.2% & 4.0% hikes in 2015 & 2016
  • 2016 active switchers: reduced premiums by 4.5% on average
  • demographic data coming soon
  • 1.15 million renewals (vs. 940K renewals last year)
  • (me: that's 1.575M QHPs total)
  • REMINDER: If you started before 1/31/16, you still have until Saturday night to finish the process

UPDATE: Offiical Press Release:

SACRAMENTO, Calif. — With three days left for consumers to finish their applications for affordable, quality health care coverage through the Patient Protection and Affordable Care Act, Covered California announced that more than 425,000 consumers had made plan selections during its third open-enrollment period.

UPDATE 4:00pm: OK, the HHS call is over now (see notes below), but now I'm on the Covered California call...and my kid gets off the school bus in 10 minutes, so it'll be a bit before I can post a fuller analysis of anything.

OK, everyone, here we go...a press call with the heads of HHS/CMS/HC.gov:

  • Secretary Sylvia M. Burwell, U.S. Department of Health and Human Services
  • Andy Slavitt, Acting Administrator, Centers for Medicare and Medicaid Services
  • Kevin Counihan, CEO, Health Insurance Marketplace

Remember, last years' total exchange enrollment was around 11.7 million nationally (8.8 million via HC.gov). HHS's official projection for 2016 was only around 10% higher (officially between 11.0 - 14.1 million, with a midrange around 12.6 million or so), while mine was more ambitious (around 25% higher overall, or 14.7 million).

Some Guy, 11/19/15:

Regular readers know that although I do spend a lot of time updating this website, I do still have to do my day job running a website development firm. As a result, I'm simply not able to keep up with every healthcare-related hot tip which comes my way.

So, when the following link was forwarded to me a few days ago, while I did find out more details from the sender, I didn't happen to get around to actually posting anything about it before today:

UnitedHealthcare Announces Changes to 2016 Exchange Sales and Compensation

Over the past few months, we've seen an acceleration of changes in the health insurance market. UnitedHealthcare is continually evaluating all aspects of the evolving exchanges so that we can provide coverage options that best meet consumers' health care and financial needs.

Coming on top of yesterday's announcement that their state exchange broke the 200,000 QHP enrollment mark this year, Washington State Insurance Commissioner Mike Kreidler has released a new report laying out the uninsured rate for the entire state population:

OLYMPIA, Wash. – The number of people without health insurance in Washington state has dropped from 14.5 percent in 2012 to an estimated 7.3 percent or 522,000 people in 2015, according to a new report issued today by Insurance Commissioner Mike Kreidler.

Nearly every county in Washington saw a drop in the uninsured

The report highlights the positive impact of the federal Affordable Care Act in Washington with county-by-county data on the uninsured and the law’s effect on many segments of the population.

Pages